Category Archives: Educational Resources

INSIDE THIS ISSUE Clinical News Retroactive Pricing Issued for Q2043 Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information CMS News CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change. Of the 52 AWP […]

RJ Health’s Chris Webb and Jason young walk through the different categories of specialty drug prices, and what is required for reimbursement with each. These webinar clips from “Shedding Light on Medically Covered Specialty Drug Pricing Methods” touch upon AWP (Average Wholesale Price), WAC (Wholesale Acquisition Cost), ASP (Average Sales Price), and how they are […]

INSIDE THIS ISSUE Clinical News Drug Reimbursement Code Price Updates Drugs/Devices New Clinical and Billing Information CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases each month and detail the rationale for the change. Of the 224 AWP Drug Code Price changes this month, […]

Join RJ’s Product and Clinical teams as they walk through the multitude of different combinations of drug claims and pricing methodologies, via clips from the webinar “Shedding Light on Medically Covered Specialty Drug Pricing Methods.” In the following clip, Chris Webb explains the main difference between HCPCS and NDC code level reimbursement. All past RJ […]

INSIDE THIS ISSUE CMS News REMINDER – New HCPCS® Codes are Now Effective Quarterly ASP (Average Sales Price) Pricing File Revised for January 2020 Hospital OPPS (Outpatient Prospective Payment System) Update January 2020 NOC (Not Otherwise Classified) Pricing File Drug Reimbursement Code Price Updates 39 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices […]

In November there were 9 new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were 2 supplemental drug approvals. The FDA had acted on assignment of 7 new product reviews. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]

INSIDE THIS ISSUE CMS News New HCPCS® Codes Effective January 1, 2020 Now Available Deleted and Revised HCPCS® Codes Effective January 1, 2020 Coming Soon Drug Reimbursement Code Price Updates 39 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices New Clinical and Billing Information CODE UPDATES Large Price Changes: We identify and report […]

$35 billion of drug-related revenue comes from healthcare provider offices. Health plans have established policies that require additional information, not just the HCPCS code. This additional information enables payors to differentiate between drugs that exist under the same billing codes. Recent claims analysis revealed a high degree of confusion from providers on what is required […]

INSIDE THIS ISSUE CMS News New HCPCS® Codes Effective January 1, 2020 Coming Soon Drug Reimbursement Code Price Updates 68 Drug Codes required a recalculation of their AWP Code Price Drugs/Devices New Clinical and Billing Information CODE UPDATES Large Price Changes: We identify and report on the codes with the most substantial pricing increases or decreases […]

In October there were 7 new drug approvals by the FDA we deemed specific to the specialty market. In addition, there were 7 supplemental drug approvals. The FDA had acted on assignment of 3 new product reviews. Drugs included in this review are generally regarded by the industry as specialty drugs.  Qualifiers may include anticipated […]